I went for a walk with Dave, the program director, after the clinic closed. It was hot, but heat doesn’t deter Dave; actually, nothing deters Dave. Even though he is only a temporary program director filling in for five months, he has attacked his position with enthusiasm and efficiency that is almost startling in this sleepy setting. Suddenly the potholes in the cement floors were filled in, the peeling walls were repainted, the Fistula Program was restarted, the elusive five-year agreement was finally signed, new latrines were being constructed, bi-weekly management meetings were held, and the fruit bowl that formerly held bananas, bananas, and more bananas was suddenly filled with papayas and pineapples and avocados and “tree tomatoes,” whatever those are. And still, at the end of the day, Dave goes for a walk or a bike-ride (that is, if he didn’t already go for a run early that morning). Every time I am stressed or frustrated or surly, he recommends emphatically that I should get out more. He’s twice my age and I can barely keep up.
We walked down the Bonga road in the strong setting sun listening to the “hellohellohello” of children and the crunching of gravel under our feet, when out of the blue Dave asked me – “So you have six months left. What are your goals?” It was a very “Dave” question.
I had no answer. No sincere answer, that is. I swallowed my sarcastic responses – “To not go crazy.” “To survive.” “ To not leave the clinic any worse off than it already is.” “To not kill anyone who would not have died anyway.” Abstract, sarcastic, evasive responses to avoid the fact that I didn’t really have any goals. Really, I didn’t think I was supposed to. I had been warned about the danger of going overseas puffed up with goals that would ultimately be inappropriate or unachievable given the circumstances, and then ending up feeling bad because I didn’t accomplish what I had set out to do. I had planned on just being open-minded and seeing what happened. To live in the moment; to be receptive; to allow the situation to change me instead of me trying to change the situation – lofty ideals, but not valid answers to Dave’s question. He meant, “What are you going to get done?” It was a fair question.
I realized I would actually feel better about our time here (i.e. I might mope less) if I had more concrete goals. Not “mission statement” type goals like “help the nurses be the best they can be” or “learn tropical medicine.” Not a “to-do” list either, like “finish the monthly report and update the pharmacy inventory.” Just manageable goals to work toward. So, here is my list.
Jessie’s Goals
Make sure each exam room is tidy (that may be an impossible goal) and has all the necessary forms and equipment
Revise the Malnutrition Program protocols (I already did that; I just put it on the list so I can cross it off)
Arrange to have the Malnutrition supplies delivered to Addis or Bonga so we avoid the painful two-day drive out to Awassa to pick them up ourselves (a tough goal, attempted unsuccessfully many times before)
Do at least two more “fistula runs” to take patients to the Fistula Hospital in Addis before we leave
Update our CHC clinic protocols (last revised two years ago) and check them against the Ethiopian clinic protocols so they are as congruent as possible
Improve clinic flow (another tough one, maybe I should take it off the list)
Work closely with the Treatment Room staff (including weekly education sessions) so they start doing again all the things they stop doing when no one is watching
Re-do my Family Practice Boards study-DVD so that I remember something about American medicine when I get home
Remain open-minded and contemplative (it’s great to have goals, but this adventure means much more to me than the sum of our accomplishments!)
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